24-hour monitoring in children with polyps of cardioesophageal junction

INTRODUCTION: Recent data suggest that the prevalence of cardio-esophageal junction polyps has increased in the recent years.

AIMS AND METHODS: To reveal the frequency of pathological gastroesophageal refluxes and disorders of acid production in children with cardio-esophageal junction polyps and in patients with chronic inflammatory diseases of upper gastro-intestinal tract without polyps. We have performed 24-hour pH monitoring in esophagus and stomach in 31 patients (26 boys and 5 girls in age within 11-17 years). The main group included 19 patients with polyps of cardio-esophageal conjunction (14 children were treated conservatively; endoscopic polypectomy was performed on five children). The control group included 12 patients with chronic inflammatory diseases of upper gastro-intestinal tract. We have made esophagogastroduodenoscopy and 24-hour pH monitoring of the esophageal and gastric contents and biopsies of polyps on all patients.

RESULTS: We have diagnosed terminal esophagitis and gastroduodenitis in all children. In main group esophagitis II prevailed (84%). In control group it was esophagitis I (79%). There were 14 children with polyps 2-5 mm in size treated conservatively, and five children with polyps more then 5 mm in size undergone endoscopic polypectomy in control group. We have found hyperplastic polyps of cardial part of stomach with inflammatory changes on histological study. 24-hour esophageal pH monitoring in the group of children with polyps has revealed physiological gastro-esophageal reflux in 11 patients (58%). In 8 patients pathological GER has been diagnosed (alkaline GER have had 4 children and acidic - 4 children). We have found physiological GER in 83% and pathological acidic GER in 17% of patients in control group. Analysis of 24-hour gastric pH monitoring has shown hyperacidity in most cases: 58% of patients in main group and 83% in control group. Study has revealed high frequency of duodenogastric refluxes in both main and control groups: 95% and 83.3% accordingly.

CONCLUSION: Therefore, the frequency of pathological GER is 2.5 times higher in the group of children having polyps of cardio-esophageal junction in comparison with control group. The frequency of acidic and alkaline pathological GER is equal in group of children with polyps. In control group only acidic pathological GER has been found. Alkaline refluxes were significantly more frequent in children with polyps in comparison with control group based on 24-hour esophageal pH-monitoring.